Managing oxygen in care homes

Source: CQC

Oxygen has been widely used medically for many years. It is a gas and you should treat it as a medicine.

Oxygen therapy

Home oxygen therapy is commonly used in care homes. It involves breathing air that contains more oxygen than normal air from a cylinder or machine. It may be prescribed for people who have a condition that causes low oxygen levels in the blood.

Home oxygen therapy can be given via a:

tube positioned under the nose (nasal cannula)

face mask placed over the nose and mouth

mask attached to an opening in the throat (tracheostomy)

Oxygen is delivered via the tube or mask from a cylinder, concentrator or ventilator machine.

Oxygen is prescribed on a home oxygen order form (HOOF). The HOOF contains details of how to use the oxygen. The prescriber sends the HOOF to the oxygen supplier who will then arrange for delivery. Tell the prescriber about any changes in a person’s clinical condition. The prescriber will organise a new HOOF if required.

Storage

Follow the manufacturer’s advice on how to store oxygen.

Store oxygen cylinders:

securely to prevent the cylinder from falling

away from areas that would block escape routes or fire exits

in well-ventilated areas

away from heat and light sources

in an area that is not used to store any other flammable materials

away from combustible material (such as paper, cardboard, curtains)

so that they are not covered by items of clothing

Store oxygen concentrators upright. Plug them directly into the mains. Do not use an extension lead.

Place statutory hazard notices in areas where you store oxygen. This includes the person’s bedroom.

Safety advice

Oxygen can be a dangerous fire hazard. Take adequate precautions while oxygen is being used.

Do not allow people to smoke where oxygen is being used.
Keep oxygen at least two metres away from flames or heat sources.
Do not use flammable liquids, such as paint thinners or aerosols, near oxygen.

Do not use petroleum based products, such as Vaseline® or Vicks®, near oxygen.

Make sure that fire alarms and smoke detectors are working.
Keep a fire extinguisher within easy reach of anyone using oxygen.

Patient safety alert

Holding stock for emergency use

If you hold supplies of oxygen for emergency use, you need appropriate equipment and storage.

Staff must be competent and have appropriate training. They must be able to order, check storage, administer and monitor the effects of oxygen.

Use a pulse oximeter to monitor the effects of oxygen administration.

Complete a risk assessment as part of a standard operating procedure or policy.

Care plans should highlight who can use the oxygen. There must not be a blanket policy for use.

Policies and procedures

Consider a procedure to inform the emergency services of the location of oxygen if they attend a fire or fire alarm.

Inform the local electricity board that a service user has home oxygen. This means that they will be aware of your special needs if the power supply is ever interrupted.

Have a policy for dealing with a person’s oxygen needs when planning trips away.

Make written information available to service users and their carers about home oxygen. This should include how to use it the risks associated with:

smoking (including risks with electronic cigarettes)

heat sources (such as heaters in bedrooms)

flammable liquids (such as aerosols)

petroleum-based products (such as Vaseline® or Vicks®)

using electronic devices (such as laptops)

Have procedures for planned preventative maintenance for regulators, piped gases and concentrators.

Points to consider

Care plans should include information about home oxygen therapy. This should include who monitors the person using the oxygen.

Documentation should cover the administration of oxygen. This should include flow rate, frequency and duration of use, and the prescriber’s details. Check these each time to make sure you’re administering the oxygen correctly.

If the person self-administers the oxygen, you need to have assessed the risks. Keep a copy of the risk assessment in their care plan.

Make sure the tubing and masks are clean and in good condition. Replace them when needed. Only use them for the person they were prescribed for.

Individual risk assessments should include information about the potential dangers of having oxygen in the care home.

Make sure staff are trained and competent to manage home oxygen therapy.

Oxygen cylinders have an expiry date. Check the dates regularly to make sure you don’t use out of date cylinders.

Return equipment to the oxygen supplier if it is no longer in use or out of date.